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Application/Redetermination & Supporting Documents …

Rev. 8/2021 Application/Redetermination & Supporting Documents Checklist Thank you for completing the Care 4 Kids (C4K) Application/Redetermination . In order to complete your application please be sure to submit the following required Documents : Parent Provider Agreement Form (4 pages) Required with all applications and redeterminations. To be completed by you and the child care provider. If your child care provider is new to Care 4 Kids, the provider s W-9 is required. Licensed Family Child Care and Unlicensed Relative providers must complete the Provider Orientation Program in order to be eligible for payment. (Register at ). If you need help finding a provider, call 2-1-1 Child Care at 2-1-1 or 1-800-505-1000.

• If paid bi-weekly or semi-monthly, submit the last 2 pay stubs • If paid monthly or annually, submit the last 1 pay stub If beginning new employment, the following are required for you and the other legal parent in your home (if applicable): ☐ …

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